Electoral registration form for registering anonymously

Electoral registration form for registering anonymously You may be able to register anonymously if you are concerned about your name and address appearing on the electoral register because you think that it could affect your safety, or the safety of someone in the same household as you. You will need to: Explain why your safety (or the safety of someone in the same household as you) would be at risk if your name and address appeared on the electoral register Provide a court document or an attestation from an authorised person to support your application (More info P4-5). How registering anonymously works If you are registered anonymously, your name and address will not appear on the electoral register and you will not be included on any registration forms sent to your address. Your electoral registration office will contact you separately. You will still be able to vote. How to register to vote 1 Fill in this electoral registration form 2 Make sure you sign the declaration 3 Provide evidence to support your application (More info P4-5 of the form) 4 Return your completed form and the relevant evidence to your electoral registration office. You can find their address at yourvotematters.co.uk 5 Problems with the form? Contact your electoral registration office if you need help completing or understanding this form or if you need this form in large print or easy to read format. You can find their address at yourvotematters.co.uk Register to vote as soon as you can, or it may be too late to vote in the next election. P1

Electoral registration form for registering anonymously Register to vote Registering to vote You can register to vote if you are: Resident (usually live) in the UK and aged 16 or over (but you will not be able to vote until you are 18). Only one person can register to vote using this form. Use black ink and write in CAPITALS. All information requested on this form must be provided (unless stated otherwise) or your application may be delayed. Registering anonymously You must also be either: A British, Irish or European Union citizen, or A Commonwealth citizen who has leave to enter or remain in the UK or who does not require such leave. Do you want to be included on the electoral register anonymously? Yes No If yes, please tell us why you want to be included anonymously. For example, because your safety or the safety of someone living in the same household would be at risk. You must provide a court document or an attestation in support of your application (More info P4-5) 1 Your name and address First name(s) Surname Your address This is the address where you live, but your name and address will not appear on the electoral register. Telephone no. (optional) Email (optional) Correspondence Address (if different) We will only use this address to contact you about your registration. Do you live at another address? No Yes Postcode Postcode 2 Changed your name? Please give us your most recent previous name (optional). Please tell us the date you changed your name (optional). P2

3 Moved house in the last 12 months? No Yes If yes, please give any previous address where you have lived during the last year or your application may be delayed. 4 Postcode If this address was overseas, were you registered in the UK as an overseas voter? No Yes Are you the only person aged 16 or over living at your current address? (optional) Yes, I am the only person aged 16 or over living at this address. 5 6 Your date of birth Your nationality If you don t know your date of birth please tick if you are: Under 18 18-75 Aged 76 or over (Don t know your date of birth? Please see section 8). If you have more than one nationality, please include them all. (Don t know your nationality? Please see section 8) 7 Your National Insurance number You may find this on your payslip, or on official letters about tax, pensions or benefits. (Don t know your National Insurance number? Please see section 8) 8 Don t know your date of birth, nationality or National Insurance number? Please tell us why If you can t provide these details we may ask you for other documentary evidence before processing your application. 9 10 11 The open register If you are included in the electoral register anonymously, no information about you will appear on the open register. Can t vote in person? If you are unable to go to the polling station in person on polling day, please choose how you would like to vote and we will send you an application form, or you can download an application form at yourvotematters.co.uk By post By proxy (someone voting on your behalf) Declaration I currently live at this address. To the best of my knowledge, the information in this form is true and the evidence to support my application is genuine. If this application includes evidence relating to someone who lives in the same household as me, the evidence which relates to them is also genuine, as far as I am aware. I understand that it is an offence knowingly to provide false information in this form and if convicted I may be imprisoned for up to six months and/or face an unlimited fine. Signature Today s date If you need help filling in this form please contact your Electoral Registration Officer. You can find their address at yourvotematters.co.uk P3

Supporting evidence You must provide a court document or an attestation as evidence that your safety or the safety of someone in your household would be put at risk if your name and address appeared on the register. Please tick the one that applies: I have enclosed an eligible court document which is for my protection (please see section A below) I have enclosed an eligible court document which is for the protection of someone in my household (please see section A below) and proof (e.g. photo driving licence or utility bill) that I live in the same household as them I have enclosed an attestation from a qualifying officer certifying that my safety would be at risk (please see section B and attestation form overleaf) I have enclosed an attestation from a qualifying officer certifying that the safety of another person in my household would be at risk (please see section B and attestation form overleaf) and proof (e.g. photo driving licence or utility bill) that I live in the same household as them. As anonymous registrations last for one year, you should keep copies of court orders or a copy of attestations for subsequent applications. If you are unsure about what supporting evidence you can provide please contact your electoral registration office. You can find their details at yourvotematters.co.uk A Eligible court documents Eligible court documents you can use to support your application: an injunction for the purpose of restraining a person from pursuing any conduct which amounts to harassment granted in proceedings under Section 3 of the Protection from Harassment Act 1997 or under article 5 of the Protection from Harassment (Northern Ireland) Order 1997 an injunction granted under Section 3A(2) of the Protection from Harassment Act 1997 a restraining order made under Section 5(1) of the Protection from Harassment Act 1997, or under article 7 of the Protection from Harassment (Northern Ireland) Order 1997 a restraining order on acquittal made under Section 5A(1) of the Protection from Harassment Act 1997, or under article 7A(1) of the Protection from Harassment (Northern Ireland) Order 1997 a non-harassment order, interdict or interim interdict made under Section 8 or 8A of the Protection from Harassment Act 1997 a non-harassment order made under Section 234A(2) of the Criminal Procedure (Scotland) Act 1995 a non-molestation order made under Section 42(2) of the Family Law Act 1996, or under article 20(2) of the Family Homes and Domestic Violence (Northern Ireland) Order 1998 a matrimonial interdict within the meaning of Section 14 of the Matrimonial Homes (Family Protection) (Scotland) Act 1981 a domestic interdict within the meaning of Section 18A of the Matrimonial Homes (Family Protection) (Scotland) Act 1981 a relevant interdict within the meaning of Section 113 of the Civil Partnership Act 2004 an interdict that has been determined to be a domestic abuse interdict within the meaning of Section 3 of the Domestic Abuse (Scotland) Act 2011 any interdict with an attached power of arrest made under Section 1 of the Protection from Abuse (Scotland) Act 2001 a forced marriage protection order or interim forced marriage protection order made under Part 4A of the Family Law Act 1996, or under Section 2 of, and paragraph 1 of Schedule 1 to, the Forced Marriage (Civil Protection) Act 2007, or under Section 1 or Section 5 of the Forced Marriage etc. (Protection and Jurisdiction) (Scotland) Act 2011 a domestic violence protection order made under section 28 of the Crime and Security Act 2010 or section 97 of, and paragraph 5 of Schedule 7 to, the Justice Act (Northern Ireland) 2015 a female genital mutilation protection order made under section 5A of, and paragraphs 1 or 18 of Schedule 2 to, the Female Genital Mutilation Act 2003. No other court documents are acceptable. The court document must be in force on the day of your application to register anonymously. P4

B Qualifying officers Only those listed below may attest an application. The attestation cannot be delegated to a more junior person within an organisation. a police officer of or above the rank of inspector of any police force in England and Wales a police officer of or above the rank of inspector of the Police Service of Scotland a police officer of or above the rank of inspector of the Police Service of Northern Ireland the Director General of the Security Service the Director General of the National Crime Agency any director of adult social services in England within the meaning of section 6(A1) of the Local Authority Social Services Act 1970 any director of children s services in England within the meaning of section 18 of the Children Act 2004 any director of social services in Wales within the meaning of section 6(1) of the Local Authority Social Services Act 1970 any chief social work officer in Scotland within the meaning of section 3 of the Social Work (Scotland) Act 1968. any director of social services of a Health and Social Services Board established under article 16 of the Health and Personal Social Services (Northern Ireland) Order 1972 any executive director of social work of a Health and Social Services Trust established under article 10 of the Health and Personal Social Services (Northern Ireland) Order 1991 any registered medical practitioner any registered nurse or midwife any person who manages a refuge. A refuge means accommodation with a planned programme of therapeutic and practical support for victims of, or those at risk of, domestic abuse or violence. Attestation form To be completed only by a qualifying officer (the qualifying officer may use a form provided by their own organisation). Full name of the applicant Name(s) of other people in the same household as the applicant to whom the attestation will apply (if applicable) I certify that the safety of the applicant, and any person[s] named above of the same household, would be at risk if the register contained the name or qualifying address of the applicant. My attestation shall have effect for (please tick one box only): The maximum period (5 years) Another period (minimum one year) Full name of the attestor Job title (as a qualifying officer) Police force / local authority / other qualifying body Telephone no. (optional) Email (optional) Signature Today s date If you are unsure about what supporting evidence you can provide please contact your electoral registration office. You can find their details at yourvotematters.co.uk P5

Your nationality If you have more than one nationality, please include them all. You can only register to vote in the UK if you are a British, Irish or European Union citizen, or a Commonwealth citizen who has leave to enter or remain in the UK or does not require such leave. We may need additional evidence about your nationality or we may check your nationality or immigration status against government records. Are you the only person aged 16 or over living at your address? You do not have to answer this question. However, every year, your electoral registration office send letters to every household to help ensure the right people are registered to vote. Your electoral registration office may not need to send these letters to your household in the near future if you let them know that you are the only person aged 16 or over living at your current address. Your date of birth If you don t know your date of birth please give the date you put on official documents (for example, your passport or driving licence). Your date of birth identifies you, confirms your eligibility to vote and can be used to call people for jury service. Changed your name? For example, you may have got married and changed your name. You do not have to give us details of your name change but it will help us identify you. If this information is not given then you may need to provide additional documentary evidence. The open register There are two registers. Why? Using information received from the public, registration officers keep two registers the electoral register and the open register (also known as the edited register). The electoral register The electoral register lists the names and addresses of everyone who is registered to vote in public elections. The register is used for electoral purposes, such as making sure only eligible people can vote. It is also used for other limited purposes specified in law, such as: detecting crime (e.g. fraud) calling people for jury service checking credit applications. The open register The open register is an extract of the electoral register, but is not used for elections. It can be bought by any person, company or organisation. For example, it is used by businesses and charities to confirm name and address details. Your name and address will be included in the open register unless you ask for them to be removed. Removing your details from the open register does not affect your right to vote. You can find out more information about both registers and how they may be used at gov.uk/register-to-vote Privacy Statement The Electoral Registration Officer will only use the information you give them for electoral purposes. They will look after personal information securely and will follow the data protection legislation. They will not give personal information about you or any personal information you may provide on other people to anyone else or another organisation unless they have to by law. The lawful basis to collect the information in this form is that it is necessary for the performance of a task carried out in the public interest and exercise of official authority as vested in the Electoral Registration Officer as set out in Representation of the People Act 1983 and associated regulations. Some of the information that is collected in this form is classified as special category personal data. This is processed for reason of substantial public interest as set out in Representation of the People Act 1983 and associated regulations. To process this type of information the Data Controller must have a relevant policy document that sets out how this information will be handled. The Electoral Registration Officer is the Data Controller. For further information relating to the processing of personal data you should refer to their privacy notice on their website. You can find their website address and contact details at yourvotematters.co.uk Problems with the form? Contact your electoral registration office if you need any help understanding or completing this form or if you need this form in large print or in another format. You can find their address at yourvotematters.co.uk P6